Muskuloskeletal Report: Meeting Rheum

Many Rheumatologists are unable to attend major medical meetings, especially those that are international. Thus, it is imperative that the news and data from these major meetings be brought to them in a timely, user-friendly, and practical manner. The CME bytes in this activity include some of the latest research and data from EULAR in the areas of rheumatoid arthritis and gout.

Overall Goal

The overall goal of this educational activity is to provide Rheumatologists with a daily review of the latest and most up-to-date data on Rheumatic diseases presented from EULAR in a practical, timely and useful manner.

Target Audience

The target audience for this CME activity is Rheumatologists and other healthcare professionals with an interest in Rheumatology.

Method of Clinician Participation

View the contents of the online CME bytes carefully and complete the respective online posttest. A minimum score of 80% must be obtained for credit to be awarded by The Foundation for Better Health Care. There is no fee for this activity. Credit for the posttest is available until June 15, 2010.

Content Validation

The Foundation for Better Health Care (FBHC) validates the content of its CME activities through a peer review process and by utilizing evidence-based medicine sources throughout the planning and implementation of its activities. Adopting the levels of evidence used by the American Academy of Family Physicians1 and the principles of evidence-based medicine outlined by Straus et al,2 the FBHC rates the level of evidence of the literature used to determine needs and learning objectives.

All recommendations involving clinical medicine are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. Further, all scientific research referred to, reported, or used in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis.

Levels of Evidence1

  • Level A (randomized controlled trial [RCT]/meta-analysis)
  • Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower-quality RCTs, clinical cohort studies, and case-controlled studies with nonbiased selection of study participants and consistent findings. High-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings are also included
  • Level C (consensus/expert opinion)
  1. Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Physician. 2002;65:251-258.
  2. Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2005.

Learning Objectives

Upon completion of this activity, participants should be able to:

Recognize the importance of early diagnosis and the role of aggressive treatment in rheumatic diseases (competence) in order to slow disease progression and improve overall patient outcomes (performance/patient outcomes)

  • Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: Report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34–45. [Evidence Level C]
  • van Dongen H, van Aken J, Lard LR, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis. A double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56:1424–1432. [Evidence Level A]
  • Breedveld FC, Weisman MH, Kavanaugh AF, et al. A multi-center, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone of adalimumab alone in patients with early aggressive rheumatoid arthritis who had not had previous methotrexate treatment: the PREMIER study. Arthritis Rheum. 2006;54:26–37. [Evidence Level A]

Recognize the importance of accurately diagnosing gout and screening for any potential comorbidities in order to treat associated conditions effectively (performance) and improve individual outcomes for patients (patient outcomes)

  • Fleishman RM, et al. Golimumab, a new human anti-TNF-a monoclonal antibody, administered subcutaneously every 4 weeks in methotrexate-naïve patients with active rheumatoid arthritis: a randomized, double-blind, placebo-controlled, GO-BEFORE study. ACR 2008; San Francisco, CA. Abstract #983. [Evidence Level A]
  • Popa C, Leandro MJ, Cambridge G, Edwards JC. Repeated B lymphocyte depletion with rituximab in rheumatoid arthritis over 7 yrs. Rheumatology (Oxford). 2007;46:626–630. [Evidence Level B]
  • Haraoui B. Is there a rationale for switching from one anti-tumor necrosis factor agent to another? J Rheumatol. 2004;31:1021–1022. [Evidence Level C]

Discuss the data supporting emerging therapies for hyperuricemia and gout (knowledge) and reflect on patients in clinical practice who may benefit from these new regimens, especially treatment-refractory patients (performance/patient outcomes)

  • Perez-Ruiz F, Atxotegi J, Hernando I, et al. Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: A prospective study. Arthritis Rheum. 2006;55:786. [Evidence Level B]
  • Schumacher HR Jr, Becker MA, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout. Arthritis Rheum. 2008;59(11):1540-1548. [Evidence Level A]
  • Sundy JS, Ganson NJ, Kelly SJ, et al. Pharmacokinetics and pharmacodynamics of intravenous PEGylated recombinant mammalian urate oxidase in patients with refractory gout. Arthritis Rheum. 2007;56:1021-1028.[Evidence Level B]

Identify rheumatic patients in your practice who may not be achieving adequate response with their current therapy (competence) and implement new management and treatment strategies in order to attain optimal therapeutic response (performance/patient outcomes)

  • van Vollenhoven RF. Switching between biologicals. Clin Exp Rheumatol. 2004;22:S115–S121. [Evidence Level C]
  • Haraoui B. Is there a rationale for switching from one anti-tumor necrosis factor agent to another? J Rheumatol. 2004;31:1021–1022. [Evidence Level C]

Needs Assessment

The FBHC has incorporated into this CME activity the relevant educational needs concerning knowledge, competence, or performance that underlie the professional practice gaps of our participants.

Accreditation

The FBHC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The FBHC takes responsibility for the content, quality, and scientific integrity of this CME activity.

Credit Designation

The FBHC designates this educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Identifying and Resolving Conflicts of Interest

The FBHC requires all planning committee members, faculty, teachers, authors, and staff of a CME activity to identify all relevant financial relationships that benefit the individual and his or her spouse or partner in any financial amount within the past 12 months. Such relationships may affect the content of CME regarding the products or services of the commercial interest.
The FBHC selects non-conflicted reviewers to "peer review" all educational material to ensure fair balance and to validate content.

The FBHC has created the FBHC Committee to Identify and Resolve Conflicts of Interest, which reviews Faculty and Staff Disclosure Statements, identifies and resolves conflicts of interest, and determines the level of participation of planning committee members, faculty members, teachers, and authors.

Independent Reviewer

Nothing to disclose

Independent Reviewer Disclosure Information

Nothing to disclose

FBHC Disclosure Statement

The FBHC is an independent professional organization that does not endorse specific products of any pharmaceutical concern. This FBHC CME activity has been independently planned by the FBHC.

FBHC Staff Disclosures

The FBHC, in keeping with the ACCME’s Essential Areas and their Elements and Standards for Commercial Support, has asked each FBHC staff member who has developed and/or reviewed content for this activity to disclose to learners all financial relationships, including those of their spouse or partner, with the manufacturer(s) of any pharmaceutical product(s), device(s), or providers of commercial services in any financial amount within the past 12 months. The FBHC staff members have disclosed the following:

Michelle Dien, Project Director
Nothing to disclose 		Sejal Patel, Account Manager
Nothing to disclose
Michael Hite, CEO
Nothing to disclose 		Nancy Larsen, Consultant
Nothing to disclose
Judy Seraphine, Consultant
Nothing to disclose 		Diane Zuckerman, RPh, Consultant
Nothing to disclose

Grantor

This program is supported by educational grants from Bristol-Myers Squibb and Takeda Pharmaceuticals North America.

Sponsor

This activity is sponsored by The Foundation for Better Health Care.

CME Activity

Watch video presentations of the MeetingRheum reports

Download Slides

Complete CME posttest

© 2010 The Foundation for Better Health Care